Nomination Form

Deadline for nominations is September 30.
The City Partner Award is presented annually by the University of Illinois Alumni Association and the UIC Chancellor. Nominations are encouraged throughout the year. Nominations are kept active for three years.

For more information, or to acquire a paper nomination form, please contact the University of Illinois Alumni Association at 312/996-8535 or e-mail alumni@uillinois.edu

INFORMATION ABOUT THE NOMINEE:

Full name: (Include name at graduation in parentheses, if different.):

Home street address:

City:

State:

Zip code:

University of Illinois degree(s) received:

Class year:

College/School/Department/Major:

Nominee's degrees from other colleges/universities:

Present occupation (Include title and company, profession, business address, etc.; if retired, date of retirement.):

State why the nominee deserves this award, and outline nominee's significant contributions benefitting the University of Illinois Alumni Association and/or affiliated organizations - alumni clubs, constituent associations, UI Foundation, athletics, college, school or department:

Career since leaving the University:

Special recognitions, honors or awards:

Contributions toward the advancement of education and the University of Illinois:

Civic activities, philanthropic endeavors:

Other information of interest:

Nominee's family - name of spouse and children - indicate if any attended/are attending the University of Illinois and degrees (This information is optional.):

INFORMATION ABOUT THE NOMINATOR

Nominated by:

Your address:

Phone number:

FAX number:

Your e-mail address (Necessary in order to process this form.):